What is the most effective treatment for patients with low HDL-C?
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Niacin is the most effective medication for raising high-density lipoprotein-cholesterol (HDL-C) levels and has mortality benefit when used as monotherapy in patients with established coronary heart disease (CHD) (SOR: B, based on a single RCT). Statins and gemfibrozil raise HDL-C to a lesser degree than niacin, but also improve outcomes in patients with CHD (statin: SOR: A, based on multiple RCTs; gemfibrozil: SOR: B, based on a single RCT). Statins are the appropriate first-line therapy for patients with concomitant elevated LDL-C and low HDL-C (SOR: A, based on multiple RCTs). When LDL-C goals are attained and HDL-C levels are still low, adding niacin improves outcomes in patients with CHD (SOR: B, based on a single RCT).
Evidence Based Practice 13(9): 01+.